Koenig's attention to the topic of religion and psychiatry is welcome (Reference KoenigKoenig, 2008). That the minority of psychiatrists have a religious affiliation is evidently beyond the scope of any intervention or policy. However, I worry that the studies quoted do not accurately reflect the situation. Although they confirm that religion is more important to service users than their psychiatrists, this does not tell us what happens in practice.

The real question which we should be asking is to service users themselves and how they feel religion has been accounted for in treatment. I worry that the answers might be even more demoralising.

Taking a spiritual history is both an easy and important task to be undertaken by any professional. It can substantially help a service user feel understood and hence engaged in treatment. The Spirituality Special Interest Group provides several tools which should surely become routine practice for all mental health professionals, at the very least in screening (www.rcpsych.ac.uk/PDF/DrSEaggeGuide.pdf).

The suggestion of prayer with service users is a troubling one with the potential to lead to transgression of boundaries through sharing such an intimate act. It leads to duplicity of the psychiatrist's role, erosion of the purpose of treatment and in my mind is best avoided.

Declaration of interest

P.C. is an atheist.